What to expect during visit to the emergency department? Leading expert in Emergency Medicine explains how patient is evaluated inside Emergency Department. What are important steps to make sure each patient gets required medical care at the right time? Dr. Anton Titov, MD. How emergency medicine doctors work with other hospital services to provide best medical care? What to Expect During Visit to the Emergency Department. Video interview with top expert in Emergency Medicine. Dr. Anton Titov, MD. Medical second opinion helps to make sure preliminary diagnosis is correct. Medical second opinion also helps to choose the best treatment for your medical condition before it becomes an emergency. Seek medical second opinion on your medical problem to avoid visit to Emergency Room later. Sometimes you are in Emergency Department, first nurse or doctor do initial assessment. This is called triage. The goal of doctors is to see patients as fast as possible. This is called door to doctor time. It is an important quality metric for Emergency Medicine department. Diagnostic studies are done, and the emergency physician's determines the need to admit patient to the hospital for further care. Sometimes patient is not too sick and serious disease is ruled out, then patient can be sent home with follow up with primary care physician on next day. What happens to patient in emergency department of hospital. What to expect in Emergency room. Dr. Anton Titov, MD. I certainly experienced that as a neurosurgery resident in Boston when a person with major trauma, in my case with the neurosurgical problem, is about to arrive to the hospital - all the services are alerted beforehand, and they are essentially waiting for the patient to roll in. You have run many situations like this as an emergency department physician. What happens once the person is in the Emergency Department? Dr. Sam Shen, MD. Director of Emergency Medicine, Stanford University. Yes, so when the patient comes to the Emergency Department, in the traditional models they are evaluated by licensed Registered Nurse, RN. Nurse does a very quick initial assessment and that function is called triage. part of triage is to determine if the patient is sick or not sick. Sometimes that patient is sick. Then that mobilizes a much faster response. Sometimes the patient deemed to be not sick or not quite as sick, that allows for the sicker patient to be cared for, and the less sick patients to be put in a different population that can still be seen in a timely fashion. But again, segregating two patient populations helps to mobilize the proper resources for the right patients. Once the patient is appropriately triaged to the area that meets the acuity of the patient. There is a goal to try to see that patient within a very brief period of time. There are many places where the goal of door to doctor time, from the second they arrive to the Emergency Department until the patient is seen by a physician should be about 15 minutes or less. that is a quality measure. It is not uncommon for many hospitals to advertise that you can be seen by a physician X period of time and that is posted on a billboard. Once patients are seen by the physician, the next step is to determine what tests, x-rays or imaging, or medications are needed to take care of the patient's problem. Once diagnostic studies are determined and the results come back, the emergency physician's role is to decide if that patient will be admitted to the hospital for further care. Do they need to be observed for a period of time to determine whether they are going to get more sick or less sick? Or do they need to be transferred to another hospital that may have specialized capability for that particular disease? Or can they be discharged home safely? so that is the critical decision point after evaluating a patient. Dr. Anton Titov, MD. These are very major points that are being decided by specifically trained physicians in emergency medicine, even before other services of the hospital are involved. It is the emergency medicine physicians that call for specialized services in the hospital to be involved in patient's evaluation and care. Dr. Sam Shen, MD. That's correct and that is the model of Emergency Medicine. When you first initially evaluate the patient, you want to formulate what you think is a diagnosis and to exclude the emergencies. Exclude the high acuity issues that could potentially be life-threatening, and potentially to stabilize the patient. beyond that if there is a very serious condition, there is a scope a practice that emergency physician can perform to stabilize the patient, such as intubation to keep airways open, chest tubes, as well as minor procedures like laceration repairs, incision and drainage and splinting. But there are going to be some services required that are more specialized. At that point emergency physician will consult that necessary specialty to assist. Sometimes a patient has appendicitis by diagnosis, the emergency physician will consult the general surgeon to come down and evaluate the patient and likely take a patient up for operative procedure. Similar with orthopedic surgery and all the other subspecialties. That is a big part of Emergency Medicine practice. We are able to identify this patient needs this resources. Hopefully we can correctly identify a diagnosis, so you can ask for the appropriate consult to assist in the care that patient. What to Expect During Visit to the Emergency Department. Video interview with top expert in Emergency Medicine. Key decision. Stay at hospital or go home?
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